Provider Demographics
NPI:1578679783
Name:DESAI, KRUTIKA (DC)
Entity Type:Individual
Prefix:DR
First Name:KRUTIKA
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HANDLEY RD
Mailing Address - Street 2:STE 220
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2177
Mailing Address - Country:US
Mailing Address - Phone:770-631-7600
Mailing Address - Fax:770-631-7604
Practice Address - Street 1:120 HANDLEY RD
Practice Address - Street 2:STE 220
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2177
Practice Address - Country:US
Practice Address - Phone:770-631-7600
Practice Address - Fax:770-631-7604
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007864111N00000X
GA07864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor